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PERMITTEE NAME/ADDRESS (IndudeFan(iryNamNlomrlon iJD+f(erenQ
<br />NAME ULUE 10UNTAiN Ehk~k;~Y, 1NCe
<br />ADDRESSD,:S~RADO flIN!:
<br />jG07 COUNTY kOAD GS
<br />FACILITY RANGLT ~ CO B1GU9
<br />LOCATION
<br />A; IN: JEFF DUeU?RT
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<br />PARAMETER
<br />AVERAGE
<br />P R SAMPLE ~'T'`d ~
<br />NATIONAL POLLUTANT DISCHARGE EDMINATION SYSTEM (NPDES) Fofm ApplOVed.
<br />DISCHARGE MONITORING REPORT (DMR) OMB NO. 2040.0004
<br />MINOi!
<br />~ ($OBR NN)
<br />PERMIT NUMBER DISCHARGE NUM9FR .'~' P _ r . ,. 4 I R8 L A h
<br />MONI i T#INGPERIOD 'P-I' ~ ~0= e Jt+J TG kLD SiASN.
<br />YEAR MO ~ YEAR MO DAY _
<br />FROM ~~.'TO ~~ j~ =~' ° S3 DISCHARGE (~) a#0
<br />. NOTE: Read Instructions before c mpleting this form.
<br />Y OR LOADING - QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />- EX of TYPE
<br />MAXIMUM UNITS MINIRII:IM AVERAGE MAXIMUM UNITS ANALYSIS
<br />ra~aen aacaox ( :,)
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<br />EFFLUENT GROSS VALU aaat: ~U *°- ?-` 5
<br />SJLIUS, 'MTAL SAMPLE 4f°~~'' aaaaFa aeuYSaa ( I))
<br />S L' S P E N U E D MEASUREMENT
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<br />EFFLUENT Gk055 YALU ~-~°% .: -~ t70/L ,+f• r'
<br />~)IL `~ GHEL56 SAMPLE :rsaaR7 R340C't O+tr.`?n0 bbRO>k4 ( ly)
<br /> MEASUREMENT
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<br />F:FPLUENT GRQ~S V11LU ~ [~~::r. a=.,, -. -„ MG L
<br />I~+JN, TOLL SAMPLE YGCRn% •fr,.dOCrr,. ;r.yrr:~}.y .~ ( 19)
<br />(g ~ F g y ' MEASUREMENT
<br />UiUUS 1 0 0 ..>~;t
<br />EFFLUENT GR035 YLLU ^'r:~~' g-- ~;= L
<br />FL"Jk, IN COEIGUIT Uk SAMPLE ( 0?y ::^~~=~^ #~r;+*>4 ~4~^#^
<br />PtihU TREATN ~itT PLAN MEASUREMENT
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<br />SJLIiiS, TOTLL SAMPLE '~aonda r<rnr.:Xn Cr>r';G:~-` ( 19)
<br />DISSOLVrU MEASUREMENT
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<br />Y I S U A L MEASUREMENT
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<br />NAME?ITLE PRINCIPAL EXECUTIVE OFFICER ICenHy under penalty of law mat
<br />d this document and ell etlecMnems were TELEPHON E DATE
<br />under my tlireution or supeMSlon In ecmrdence wim a eyetem designed
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<br />TYPE OR PRINTED i,,,.e.n..,,.n,e.,,,..;nm«,.ar„e.,,ni,.,,.a.,.,,..,..,r r,,. ~.,,,~.a.,,. ,,~.a.«,..,. OFFICER OR AUTHORIZED AGENT
<br />,........NUMBER
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<br />~iL E Gftr:A5E k::PORTIhG-SEE IeB.1.F, P,7 PII. ~RT,RLY SA'1PLING INSTkUCTIONS-LeCe9, Y'[C~{4'`1'I•
<br />EPA Form 33201 (REV 3/99) Previous editions may be used. OQ429 / DO O 71 ! ISi~A4PART FORM PAGE 1 OF
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